الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Caudal analgesia is the most popular and commonly used regional block in pediatric surgery. Caudal administration of ketarnine produces adequate analgesia when administered alone , and prolongs the duration and improves quality of analgesia when combined with bupivacaine. Also, addition of clonidine to bupivacaine for caudal blockade has been used to potentiate postoperative analgesia. The present study compared the analgesic efficacy and hemodynarnic and respiratory effects of clonidine 2 &kg or ketarnine O.Srng/kg, added to 0.25% bupivacaine for caudal blockade in pediatrics who underwent repair of inguinal hernia. This study was conducted on 45 pediatric patients subjected to elective unilateral inguinal hernia repair whose ages ranged from 1-6 years.Patients were randomly allocated to one of three groups. each group contained 15 patients. group I, patients received 1 mlkg 0.25% bupivacaine. group 11, patients received ketamine 0.5 mgkg added to bupivacaine 0.25% 1 mllkg. group 111, patients received clonidine 2pgkg added to bupivacaine 0.25% 1 ml/kg. We monitored percutaneous oxygen saturation, (Spa*), electrocardiography (ECG), heart rate (HR) and blood pressure in the intra-operative and post-operative periods.Also, we assessed the quality and duration of analgesia, duration of motor block, time of first spontaneaus voiding and any side effects. The results of this study showed that: There was significant increase in the quality and duration of analgesia in the Bupivacaine - Ketamine group and Bupivacaine - clonidine group in comparison to the bupivacaine group. The duration of analgesia in the bupivacaine - ketarnine group was 11 -5 hours and the duration of analgesia in the bupivacaine - clonidine group was 10.5 hours. However, the duration of analgesia in the bupivacaine group was 5.1 hours. There was significant increase in the degree of sedation in bupivacaine - clonidine group compared to bupivacaine group or bupivacaine - ketamine group for 3 hours in the post-operative period however, this sedation was not troublesome. Although, there was a significant decrease in heart rate in bupivacaine - clonidine group at 20 min. after caudal injection of the Summary ~ndConclicsion 108 drug. This decrease in heart rate was not of clinical significance and did not need therapeutic intervention. There was no significant change of mean arterial pressure after caudal injection in the different three groups. Also there was no case of respiratory depression. There was no significant difference between the three groups as regards to duration of motor block and time of first spontaneous voiding. In conclusion, administration of bupivacaine 0.25% lmVkg is valuable in providing analgesia . However, addition of ketarnine (0.5 mag) or clonidine (2pgkg) to bupivacaine 0.25% lmllkg increase the quality and duration of analgesia without significant side effects.